Appendix II APPLICATION FORM FOR FINANCING

For business. For growth. For life.
Appendix II
APPLICATION FORM FOR FINANCING
A) COMPANY / FIRM INFORMATION
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This form is provided free of charge.
The Bank does not appoint any third party for financing application activity.
Name of Company / Firm
Registration No. of
Company / Firm
Registration Date
(dd/mm/yy)
Address of Company /
Firm
Main Business Activities
Telephone Number of
Company / Firm
Total Financing
E-mail of Company /
Firm
RM
Purpose of Financing
Contact Person*:
Full Name
MyKad No
Position
Telephone No.
* Directors/Shareholders/Owners (who are not from third parties)
The documents below must be submitted along with the Application Form:
1) A copy of identity card for all owners or partners (firms), the shareholders and directors of the company (Sdn.
Bhd.)
2) Company/Firm registration form
B) DECLARATION
It is with this that I/we confirm that :1. I/We certify that all information forwarded to SME Bank as per the checklist above and any additional information
to be provided to Small Medium Enterprise Development Bank Malaysia Berhad (from time to time as required) are
true updated and complete.
2. I/We confirm to the best of my knowledge and belief, there is no false or misleading statement contained in, or
material omission from, the information that is provided to SME Bank in relation to the application.
3. I/We authorized the Bank to verify the information in respect of any other party, and give it to those who are
deemed necessary.
4. The Bank reserves the right to reject the application if it appears that the details provided are incorrect.
5. Directors of the company are not bankrupt.
6. The company claims to have no access to financial institutions other than the information that has been disclosed.
7. I/We hereby authorized the Bank to refer this application to any party involved should this application are outside
the scope of SME Bank.
8. I/We hereby authorized SME Bank to verify and/or make any checks and/or obtain any information and/or
confirmation at any time and from time to time now and/or in the future, with or from any credit/financing
reference/reporting agencies, including but not limited to CCRIS, CTOS and/or any other agencies and/or from any
financial institution(s) and to provide such aforesaid party(s) with the required information requested to enable
SME Bank to ascertain my status and/or any other person, individual and/or entity related to and/or associated
with me as may be required by SME Bank for the purpose of considering this application and thereafter if this
application is approved for the purposes of the grant and/or continued maintenance of the facility; and/or recovery
of financing owing under this facility; and/or any purpose related to or in connection with the facility applied for;
and/or for any other purpose that is required or permitted by any law, regulations, guidelines and/or relevant
regulatory authorities.
9. For financing which does not exceed RM250,000.00 and requires a guarantor, I/we agree to:
a) Disclose in writing to the guarantor of the financing facility obtained from any of the financial institution(s) and
the assurances given by me/us to the other side. A copy of the letter will be given to SME Bank.
b) To authorize SME Bank to disclose information relating to the financing of correspondence between me/us and
SME Bank to the guarantor for the duration of the financing.
10. I/We authorized SME Bank to disclose my/our information to the following parties:
a) The Government, fund provider, ministries or other authorities, agencies or bodies which have jurisdiction over
SME Bank;
b) The auditor, lawyer or professional advisors appointed by SME Bank;
c) The collateral provider under the financing facility;
d) The Bank’s group of companies;
e) In accordance with any sapina or other legal provisions or in connection with any legal action, suit or proceeding
related to financing facilities;
f) According to any law; and
g) As required by Bank Negara Malaysia.
11. SME Bank to share my/our information (excluding information relating to the business or my/our account) with
third parties for strategic alliances, marketing and promotion needs to get my/our consent.
12. Disclosure to SME Bank group of companies to ease the operations, business, cross-selling and other purposes of
the Bank and/or it subsidiaries provided that the disclosure for cross selling purposes will not be carried out if we
disagree by informing the Bank via the phone or mail (which can be changed by the Bank from time to time by
notice to me) Level 21, Menara SME Bank, Jalan Sultan Ismail, 50250 Kuala Lumpur, Tel: 1-800-88-3131.
13. I/We have read the "Personal Data Protection" ('Notice') before completing this form. By submitting personal data,
I/we, and by signing this form, I/we hereby authorized and agree to the terms of the Notice is available on the
Bank's website at www.smebank.com.my and Enterprise Centers.
14. Clause ‘Opt-Out’
If you/your company does not want to receive any marketing materials about the products and / or special
offers from the Bank. Please tick
here.
DEVELOPMENT FINANCIAL INSTITUTIONS ACT (DFIA 2002)
Pursuant to Section 28(3)(b) of the Development Financial Institutions Act 2002 (DFIA), Small Medium Enterprise
Development Bank Malaysia Berhad (hereafter to be referred to as SME Bank) is prohibited to grant any financing
facility to any individual, company, partnership or sole proprietorship (hereafter to be referred to as the customer)
where any of its directors, managers, agents or guarantors has family relationship with any of SME Bank’s members,
directors or officers. For the purpose of this clause, family relationship refers to the director or officer’s spouse, child or
parent as defined under the DFIA. SME Bank may withdraw or terminate any financing facility granted to any customer
should the Bank found out that the granting of financing facility contravened with the above restriction.
As such, I hereby declare that I do not have any family relationship with SME Bank’s directors or officers and shall
inform SME Bank should such relationship exist in the future. In addition, I also declare that I am free from any act of
bankruptcy, not involved in any unlawful activities under the Anti-Money Laundering, Anti-Terrorism Financing and
Proceeds of Unlawful Activities Act 2001 (AMLATFPUAA 2001) and/or any legal action. I undertake that all
information provided to SME Bank is true, complete and was done in a transparent manner. I hereby agree to accept
any decision made by SME Bank with regard to my financing application.
NO DECLARATION OF FAMILY RELATIONS
I/We, the undersigned are representatives hereby declare that no director, manager, agent or surety company has any
family relationship as a spouse, child or parent of any director or executive of SME Bank at this time. I/We also
undertake to inform SME Bank or if there arises any communication as mentioned above at any time.
………………………………………….
(Authorized Personnel)
Name :
Position :
Company Stamp :
Date :
How do you find out about us? (You can tick
more than one)
Word of mouth
Website Ad / Search
Advertisements (Print / Electronic)
Social networks
(Facebook / Twitter / Youtube)
Media coverage
Others:
Please specify: ___________________
Small Medium Enterprise Development Bank Malaysia Berhad 49572-H
Menara SME Bank, Jalan Sultan Ismail, 50250, Kuala Lumpur. | Call Centre: 1800-88-3131
E-mail: [email protected] | Website: www.smebank.com.my | Facebook.com/smebank | Twitter.com/sme_bank